This paper provides the practical experience of developing an eLearning technology as a tool to implement Competency-based Medical Education (CBME) in Tanzania medical universities, with a specific focus on Muhimbili University of Health and Allied Sciences. The paper provides a background to eLearning and the early attempt to adopt it in 2006 at MUHAS, with its challenges leading to failure. Next it presents the strategic re-establishment of eLearning to support the new CBME introduced in 2009. Finally, the paper discusses the challenges faced during the implementation process and provides a discussion of lessons learnt. The paper suggests that, in order to improve the quality of medical education in settings with limited resources, universities in developing countries should make effective use of innovative and emerging technologies relevant to their environments. Successful implementation of eLearning requires a strategic approach which should involve university management, academic staff and students. The approach should take into account significant issues including pedagogy, ICT infrastructure, appropriate technologies, human resources, eLearning policy, faculty and student training, integration of eLearning and information literacy as well as the university curricula and partnerships.
Keywords: eLearning; competency based medical education; Information and Communication Technology; medical education;
ELearning has been widely regarded as a new innovative methodology in effectively delivering knowledge and skills, in many disciplines, to large and scattered student communities (Davis et al. 2006). ELearning refers to the use of electronic equipment, computer-based devices and internet based application to facilitate the process of teaching and learning (Nichols 2003; Benninck 2004). ELearning is also called Web-based learning, online learning, distributed learning, computer-assisted instruction, or Internet-based learning (Ruiz & Mintzer 2006). Using eLearning, students are able to learn at their own pace, at their convenient times, chosen media and learning sequences (Chodorow 1996). It also stimulates active learning whereby students have the freedom to share, discuss and contribute in the process of learning, with their educators and peers (Ruiz & Mintzer 2006). Educators become facilitators of the learning process rather than deliverers while students become participants rather than listeners (Hamburg, Lindecke & Thij 2003; Ruiz & Mintzer 2006).
Learning technologies can effectively be used to implement CBME. CBME has emerged in the health professions to address criticisms of contemporary approaches to training (Frank, Snell, et al., 2010; Ruiz, Mintzer, & Leipzig, 2006). Competency-based medical education refers to "an approach to preparing physicians for practice that is fundamentally oriented to graduate outcome abilities and organized around competencies derived from an analysis of societal and patient needs. It deemphasizes time-based training and promises greater accountability, flexibility, and learner- centredness" (Frank, Mungroo, et al., 2010). CBME is organized around competencies, or predefined abilities, as outcomes of the curriculum (Frank, Snell, et al., 2010). The integration of learning technologies into medical education can catalyse the shift towards individualized (adaptive learning) and collaborative learning, where instructors do not only serve mainly as the distributors of content, but will become more involved as facilitators of learning and assessors of competency (Ruiz et al., 2006).
Studies show that electronic-based learning appears to be effective as traditional instructor-led methods such as lectures in medical diverse education (Casebeer et al. 2008; Curran et al. 2006; Choules 2007; Lwoga 2012; Muhsin 2008; Davis 2006). For example, a study of the eLearning experiences of students in two universities in Ghana revealed that eLearning programmes were "more effective" in comparison to other methods of learning (Adanu et al. …